How to Talk About Universal Health Care Insurance: Part 1

A few weeks ago I posted a diary titled How to Talk to Small Business People . So many of the comments were about health care issues that it become apparent that this was a topic in desperate need of further conversation. So instead of "How to Talk To..", today it is "How to Talk About..."

Usually you will see this subject discussed using the short hand of "Universal Health Care" as if that were the issue. That is not the issue. As we will see below the fold, we already have Universal Health Care. What we do not have is Universal Health Care insurance.

So follow along and we'll see what can be done about this situation.

We need to make one thing perfectly clear right from the start. That is that we do not have a health care crisis in this country. We do have a health care insurance crisis. No one in need of care who presents themselves for treatment is denied treatment. Ok, almost no one. But the general rule is that if you present yourself for health care, you will receive it. From VOANews.com:

Karen Davenport, executive director of health care policy for the Centerfor American Progress:"The ones that are probably of greatest concern would be the people who areuninsured who delay care and who end up using not just emergency room services,but more complex, more complicated, more intensive services when they do getcare," she said.

Since they are uninsured, these patients run up bills that they are unable to pay. More from VOANews:

"I think that we provide a high amount of uncompensated care here at Children's National Medical Center, anywhere from $28 and $30 million a year that we report that is provided as uncompensated care," noted Chavanu. "And that's really approximately eight to ten percent of our population."
According to the American Hospital Association, hospitals doled out $27 billion in uncompensated care in 2004.

Like any other business, hospitals pass along the cost of bad debts to their other customers in the form of higher prices. Unlike other businesses, hospitals are not able to control their credit risk. They treat whoever shows up. We all wind up paying for this in the form of higher hospital bills which ultimately turn into higher health care insurance premiums. So what can be done to alleviate this situation?

MALCOLM GLADWELL lays out some of the facts about our current health care system in this article in the New Yorker:

Americans spend $5,267 per capita on health care every year, almost two andhalf times the industrialized world’s median of $2,193; the extra spending comesto hundreds of billions of dollars a year.

<snip>

The United States spends more than a thousand dollars per capita peryear—or close to four hundred billion dollars—on health-care-related paperworkand administration.

Other countries pay around 30% of what we spend on health care related adminstrative overhead. Between the uncompensated service hospitals provide and the excess cost of administration, there is about $300 billion needless spending in our current health care system. That comes to more than $1,000 per year for every man, woman and child in this country.
So we have plenty of room for improvemnt in the administration of our health care delivery system. There is one other myth to bust about health care in this country. We already have a working model for a single payer health care system up and running in the United States. It is called Medicare.

So who are the uninsured? The Census Bureau provides us with this information:

• In 2004, 45.8 million people were without health insurance coverage, up from 45.0 million people in 2003.
• The percentage and number of children (people under 18 years old) without health insurance in 2004 was 11.2 percent and 8.3 million.
• With a 2004 uninsured rate at 18.9 percent, children in poverty were more likely to be uninsured than all children.
• The uninsured rate and number of uninsured in 2004 was:
• 11.3 percent and 22.0 million for non-Hispanic Whites, and
• 19.7 percent and 7.2 million for Blacks.
• The number of uninsured increased in 2004 for Hispanics from 13.2 million in 2003 to 13.7 million; their uninsured rate was 32.7 percent.

These figures show us that an undue burden is placed on people of color, who also tend to be at the lower levels of the socio-economic ladder. Blacks and Hispanics make up 46% of the uninsured population. They account for only 19% of the total population.
How about some characteristics of the uninsured? Again, from the Census Bureau :

• 73% of the uninsured in the workforce worked sometime during the year.
• 63% of the uninsured who worked during the year worked at companies with fewer than 100 employees.
• 62% of the uninsured in the workforce had a high school diploma or less.

It turns out that the uninsured are not only the unemployed. In fact, nearly 3 out of 4 uninsured in the workforce had been employed during the year. Of this group, nearly 2 out of 3 worked for small businesses (less than 100 employees.) And nearly 2 out of 3 uninsured in the workforce had only a high school diploma or less.

Some of the issues and makeup of the health insurance problem have been laid out. This is the first step. In Part 2, we will talk about some proposed solutions and how to talk about them.

In the meantime, talk amongst yourselves. But be gentle.

Children Aren't Safe in Save Children

Free Our Kids has Youtube videos of a boy named Justin who was physically abused in the Florida Department of Children and Families program Save Children. Justin was stabbed with pencils and burned with cigarettes by his foster parents. Justin tells the interviewer that his foster parents wanted him to break into houses.

Democracy: A Very Messy Business

A tyrant is deposed and executed. The long suffering majority, oppressed by the tyrant and his band of cohorts begins a blood letting in retribution. "Dead Ender" supporters of the deposed regime attempt to fight back. The American Secretary of State expresses his strong support for the new government in their struggle against these "Dead Enders". The President of the United States exceeds his constitutional authority because he believes it is in the best interests of the country.

Any of this sound familiar? Is this Iraq we are talking about.....?


All of these dire predictions coming from the Bush Administration about what will happen if we pull out of Iraq got me to thinking about this. I am a Viet Nam veteran, so I well remember the Domino Theory which did not come to pass. So, who were we talking about above the fold? Why, only the country most of us love and many Americans love to hate. So how did France get from a monarchy to the republic that it is today? According to Wiki:

The French Revolution (1789-1799) was a vital period in the history of France and Europe as a whole.... While France would oscillate among republic, empire,and monarchy for 75 years after the First Republic fell to a coup d'état, the Revolution is widely seen as a major turning point in the history of Western democracy — from the age of absolutism and aristocracy, to the age of the
citizenry as the dominant political force.

This was not achieved witout a considerable amount of blood letting. But who was this American Secretary of State who supported the Revolutionaries in France? Why none other that the principal author of the Declaration of Independence:

Sensing rising criticism of the excesses of the French Revolution in the letters of William Short (1759-1848), his handpicked chargé des affaires in Paris, Secretary of State Jefferson sharply chastised Short and praised the revolution despite its rising irrationality and violence: "and was ever such a prize won with so little innocent blood? my own affections have been deeply wounded by some of the martyrs to this cause, but rather than it should have failed, I would have seen half the earth desolated. were there but an Adam and Eve left in every country, left free, it would be better than as it now is."

And the American President who exceeded his constitutional authority? Why none other than that self same Thomas Jefferson who executed the Louisiana Purchase even as he was doubtful of his own authority to do so.

I guess my point in all this is that all these dire predictions of the Bush Administration about what will happen if we were to leave Iraq are just not either or propositions. There are many things we could do to prevent these bad consequences that do not involve keeping our troops in Iraq to referee a Civil War. On Meet The Press today, Senator Hagel touched on a plan that has been diaried here. So our King George wanted to establish a democracy in Iraq. He has.

Maybe he should have been careful about what he wished for.

Kathy Castor Press Release

I got this email from Kathy Castor's office.

***

U.S. Representative Kathy Castor was named today by Speaker Nancy Pelosi and House leaders to serve on the U.S. House of Representatives Armed Services Committee. "The Armed Services Committee is vital to the safety and security of our country and my community", said Castor.

"I will fight to protect MacDill Air Force Base, which is home to U.S. Central Command, U.S. Special Operations Command, and the 6th Air Mobility Wing", continued Castor.

This week the Armed Services Committee will begin Iraq oversight hearings featuring Secretary of Defense Robert Gates and the Chair of the Joint Chiefs of Staff, General Peter Pace.

"I will ask the tough questions on the war in Iraq," stated Castor.

News reports say that President Bush is considering escalating the war in Iraq. "Escalation of the war in Iraq is out of step with the American people, out of step with my neighbors in Hillsborough, Manatee and Pinellas counties and out of step with the Generals on the ground," observed Castor.

Speaker Nancy Pelosi has said that in the past the Bush Administration has been given a blank check on Iraq. "As a result, the Speaker has stated that any escalation in Iraq will have to bear the toughest scrutiny and serving on the Armed Services committee will allow me to play an active role in that tough scrutiny", Castor said.

"Our number one challenge today is ensuring that American troops and their families are being supported. We must be "ready" as a nation to confront challenges to our national security. Under the new Congress and through my service on the Armed Services Committee, troops and veterans will be ensured of health care and the equipment they need," concluded Castor. "Oversight of waste and fraud will also be my focus as a member of the Armed Services Committee".

The powerful House Armed Services Committee, the largest authorizing committee in Congress, is responsible for the nation's entire $393 billion defense budget. It has jurisdiction over military installations and facilities in this country and abroad, personnel, procurement, military research and development and readiness issues. The committee also has special oversight responsibilities over international arms control and disarmament and the education of military dependents.

Congresswoman Kathy Castor represents the 11th Congressional District of Florida. She has already been appointed to the powerful Rules Committee and Steering and Policy Committee, where she is already working hard to bring needed changes for her neighbors in Tampa Bay.

***

The question I emailed back to Castor's office is will the Congresswoman support or urge a withdrawal of troops from Iraq. Maintaining checks against the executive branch is fine. That is something that should have been done a long time ago. Will Castor try to put an end to Bush's mad war? That is the question her constituents will want to know.

Polls I have seen show little support of an increase of U.S. troops. We also don't have the troops to spare. Politically and in the name of sanity, opposing Bush on the troop surge is the right thing for the Democrats to do. I don't believe that Democrats would be hurt by asking for a withdrawal. Nancy Pelosi has backed away from doing so. She should do so. The public is losing it's patience with this war. Let Bush and the Fox News dittoheads cry about how Democrats are weak on national security while they defend staying the course and why Osama bin Laden is still at large.

All You Gotta Do is Act Locally

After the 2000 Presidential election debacle in Florida, I did what many of my fellow Floridians did. After I got done slamming my head up against the wall and puking at the sight of Katherine Harris (I still do that, BTW), I started doing some soul searching and some number crunching.

What came out of that was the realization that if we had just been a little smarter, worked just a little harder, we could have changed the course of history. And it was right there in front of us the whole time.

So, below the fold, I'm gonna take you to the big time, all you gotta do is...


Regardless of what we think of it, the final official vote count in Florida for the 2000 Presidential Election had Al Gore losing Florida's then 25 Electoral Votes to George W Bush by 537 votes. After the Supremes sang their final tune, ole Al sang "Turn out the lights, the party's over". And that was all she wrote.

How could this have happened? We had the butterfly ballot in Palm Beach County. We had hanging and pregnant and dimpled chads. We had the Goper Goon squad led by John Bolton (yeah that John Bolton) beating on the glass at the Miami-Dade County Supervisor of Elections office.

But all of that should not have mattered. There are those who say elections are never perfect. The only time we even care about this crap is when the elections are so close. And you know, they're right. Any plan conceived by humans becomes worthless once the opening bell rings. But it didn't have to be that way.

I live in Pinellas County Florida. Pinellas is the western anchor of the infamous I-4 Corridor in Central Florida. It is now the swing County in the swing region in the swing state. I bet my fellow Pinellans didn't get it that we are such swingers. We swung to Al Gore by 10,000 votes, so you'd think we could say we did our part. But that ain't the whole truth. The sad fact is we left 10,023 votes on the table in Pinellas. That is the number of votes rung up by erstwhile Green Party candidate Don Quiote de la Nader. Don Ralph Nader and company can be said, fairly or unfairly to have cost Al Gore the White House.

You could use the John Kerry 2000 Electoral analysis. His answer when asked in early 2003 how her was going to win in the South was an absolute classic. After his jaw stopped tightening up and his face stopped turning red, here's what he said:

If Al Gore had won New Hampshire, he'd be President of the United
States.

The last time I checked, New Hampshire was not even is Southern New England, much less the Southern United States. But that was the way Kerry looked at it. I shoulda, known, I shoulda known. I did work for Bob Graham's abortive campaign, and then sat back as Kerry claimed the nomination. And there wasn't nuthin I could do about it. So, I got on the Kerry Bandwagon and did what I could for him. But we all know how that turned out.

So, here we go into the the nascent stages of the 2008 Presidential campaign cycle. John Edwards and Tom Vilsack have announced. A host of others from Biden to Clinton to Obama and some in between are lined up waiting their turn to jump.What are we going to do this time to make the outcome better?

I tried something in the 2004 cycle. I tried to snake some of those 10,000 Ralph Nader votes back from our Green Party friends. I went to Green Party gatherings and made nice. I listened to what they had to say. I found where where our values overlapped. And I took to heart something that is the Green Party Mantra:

Think Globally and Act Locally

Once that sank in, I think I helped make a difference. And I don't think I'm anything special, or that I did anything all of y'all could have done and probably done better than I did. Ralph Nader was again on the ballot as the Green Party candidate in 2004. My pitch to the Green's was pretty simple. Greens and Dems share most of the same values. Greens could make an impact on the Dems and move the Party in their direction if the got in the game on the side of the Dems. And the clincher was my sig line:

You cain't govern if you cain't win

Did it work? Well, John Kerry lost Pinellas County by 226 votes. But Ralph Nader only got 2,042 votes in Pinellas. Did we pick up an additional 8,000 votes for Kerry? I don't know. I'd like to think so. I know we got some, maybe most.

And all I had to do was act locally.

Values Based Foreign Policy

As the 110th Congress is getting ready to come into session, I have been thinking quite a bit about a Values Based Foreign Policy. The Democrats in Congress have been shut out of any meaningful role in US foreign policy for six long years. Now, with the advent of Democrats in control of Congress seems to me a good a time as any to write about how we define our foreign policy parameters.

I will confess first that I have been thinking about this in terms of Values Based Decision Making, but otherwise within the vacumn of my own little noggin. A little research quickly showed me that, once again, I have not come up with anything particularly original. But I still believe a discussion of this topic is particularly timely. So, here we go...


I had intended to start this diary off with a discussion of the famous "Long Telegram" by George Keenan which was published in Foreign Affairs in July 1947 as The Sources of Soviet Conduct by X. It was in this article that the policy of "Containment" of the Soviet Union was first and most famously espoused. I was, in fact, all set to blame Keenan for all the sins against "values based foreign policy" committed in the name of "containment". Imagine my surprise then upon re-reading this article and discovering this:

It is rather a question of the degree to which the United States can create among the peoples of the world generally the impression of a country which knows what it wants, which is coping successfully with the problems of its internal life and with the responsibilities of a world power, and which has a spiritual vitality capable of holding its own among the major ideological currents of the time. (Emphasis mine)

And this, the conclusion of the article:

Thus the decision will really fall in large measure on this country itself. The issue of Soviet-American relations is in essence a test of the overall worth of the United States as a nation among nations. To avoid destruction the United States need only measure up to its own best traditions and prove itself worthy of preservation as a great nation.

Surely, there was never a fairer test of national quality than this. In the light of these circumstances, the thoughtful observer of Russian-American relations will find no cause for complaint in the Kremlin's challenge to American society. He will rather experience a certain gratitude to a Providence which, by providing the American people with this implacable challenge, has made their entire security as a nation dependent on their pulling themselves together and accepting the responsibilities of moral and political leadership that history plainly intended them to bear.

In essence, Keenan was saying that we only had to live up to our values to ultimately prevail. Forty years later, in 1987, Keenan had this to say about "containment":

There are many other sources of instability and trouble. There are local danger spots scattered about in the Third World. There is the dreadful situation in southern Africa. There is the grim phenomenon of a rise in several parts of the world of a fanatical and wildly destructive religious fundamentalism, and there is the terrorism to which that sort of fundamentalism so often resorts. There is the worldwide environmental crisis, the rapid depletion of the world's nonrenewable energy resources, the steady pollution of its atmosphere and its waters -- the general deterioration of its environment as a support system for civilized living.

And finally, there is much in our own life, here in this country, that needs early containment. It could, in fact, be said that the first thing we Americans need to learn to contain is, in some ways, ourselves: our own environmental destructiveness, our tendency to live beyond our means and to borrow ourselves into disaster, our apparent inability to reduce a devastating budgetary deficit, our comparable inability to control the immigration into our midst of great masses of people of wholly different cultural and political traditions.

At this juncture, I was going to launch into my own discussion of the pitfalls of the so called "pragmatic approach" to foreign policy versus the "values based" model. I still intend to do so in future diaries. I would be entirely remiss if, at this time, I did not offer my apologies to the late George Keenan, a man who 60 years ago typed these words on his typewriter:

gratitude to a Providence which, by providing the American people with this implacable challenge, has made their entire security as a nation dependent on their pulling themselves together and accepting the responsibilities of moral and political leadership